Posted: June 14th, 2023

Although there is a movement called the APRN Consensus Model

Now that you are in your final course in your program, it is time to turn in earnest to preparing for certification and licensure. You will need to take and pass a national AGPCNP certification exam. Once certified, you will then be eligible to apply for licensure as an advanced practice registered nurse (APRN) in the state desired. It will be up to you to ensure you are knowledgeable about the practice agreements, scope of practice, and prescriptive authority in your state.

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Although there is a movement called the APRN Consensus Model to standardize NP regulations nationally, it is still the case that requirements vary state to state. In some states, NPs may establish independent practice without the supervision of an MD. Additionally, states are currently categorized as either allowing full practice, reduced practice, or restricted practice. Full practice states allow NPs to evaluate, order diagnostics, diagnose, and treat patients. They are licensed under the exclusive authority of the state board of nursing for the appropriate state. Many states may require prescriptive authority protocols in addition to collaborative agreement.

Another important area to consider and plan for is prescriptive authority. Prescriptive authority is granted under state law by the appropriate board. The board granting prescriptive authority may be the medical board, state board of pharmacy, or nursing board for the appropriate state licensure being pursued. The authority to write for a controlled substance is granted at a federal level and is verified through the Drug Enforcement Administration (DEA) by the appropriate state board. Drug Enforcement Agency registration is granted at the federal level and has additional requirements/fees for the registration process.
Finally, the legal landscape for NPs is constantly changing as the status of NPs as providers improves on a national level. Legislative changes may occur annually, bi-annually, or during an emergency legislative meeting at the state or federal level. These legislative sessions and any subsequent changes will significantly impact your scope of practice as a nurse practitioner.
For this Discussion, you examine professional issues for your state, including certification and licensure, scope of practice, independent practice, prescriptive authority, and legislative activities.

To prepare: My state is Texas
Review practice agreements in your state.
Identify whether your state requires physician collaboration or supervision for nurse practitioners and, if so, what those requirements are.
Research the following:
How do you get certified and licensed in your state?
What is the application process for certification in your state?
What is the primary nurse licensure office resource website in your state?
How does your state define the scope of practice of a nurse practitioner?
What is included in your state’s practice agreement?
How do you get a Drug Enforcement Agency (DEA) license?
How does your state describe a nurse practitioner’s controlled-substance prescriptive authority and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?
In what legislative and advocacy activities are your state nurse practitioner organization(s) involved?
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Here are the answers to your questions:

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Review practice agreements in your state.

In Texas, nurse practitioners (NPs) are required to have a practice agreement with a collaborating physician. The practice agreement must be in writing and must include the following information:

The scope of practice of the NP
The responsibilities of the NP and the collaborating physician
The process for resolving disagreements between the NP and the collaborating physician

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Identify whether your state requires physician collaboration or supervision for nurse practitioners and, if so, what those requirements are.

Texas requires NPs to have a collaborative practice agreement with a physician. The agreement must be in writing and must include the following information:

The scope of practice of the NP
The responsibilities of the NP and the collaborating physician
The process for resolving disagreements between the NP and the collaborating physician

Research the following:

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How do you get certified and licensed in your state?

To become certified and licensed as an NP in Texas, you must:

Complete an accredited graduate-level nursing program in a relevant area of practice.
Pass the national certification exam for your specialty.
Apply for licensure with the Texas Board of Nursing.

What is the application process for certification in your state?

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To apply for certification in Texas, you must:

Complete the application form.
Pay the application fee.
Submit your transcripts.
Submit your national certification exam results.

What is the primary nurse licensure office resource website in your state?

The primary nurse licensure office resource website in Texas is the Texas Board of Nursing website. The website provides information on the application process for licensure, the requirements for licensure, and the rules and regulations governing the practice of nursing in Texas.

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How does your state define the scope of practice of a nurse practitioner?

The Texas Board of Nursing defines the scope of practice of a nurse practitioner as follows:

A nurse practitioner is a registered nurse who has completed an advanced practice nursing program and has been certified by a national certifying body. Nurse practitioners are qualified to provide a broad range of health care services, including diagnosis, treatment, and prescribing of medications.

What is included in your state’s practice agreement?

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The practice agreement between an NP and a collaborating physician in Texas must include the following information:

The scope of practice of the NP

The responsibilities of the NP and the collaborating physician

The process for resolving disagreements between the NP and the collaborating physician

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How do you get a Drug Enforcement Agency (DEA) license?

To get a DEA license in Texas, you must:

Complete the DEA application form.
Pay the application fee.
Submit your fingerprints.
Submit a copy of your certification.

How does your state describe a nurse practitioner’s controlled-substance prescriptive authority and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?

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In Texas, NPs are authorized to prescribe controlled substances in Schedules II-V. The specific drug schedules that an NP is authorized to prescribe are determined by the NP's certification.

In what legislative and advocacy activities are your state nurse practitioner organization(s) involved?

The Texas Association of Nurse Practitioners (TANP) is the state professional organization for NPs in Texas. TANP is involved in a variety of legislative and advocacy activities, including:

Advocating for increased access to health care
Promoting the role of NPs in the health care system
Protecting the rights of NPs

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Conclusion

The requirements for certification and licensure, scope of practice, independent practice, prescriptive authority, and legislative activities for NPs vary from state to state. It is important to research the requirements in your state before you begin your NP program.

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